Person-centred Care in CKD: The CKD-SMS Study

People with chronic conditions must take an active role in their healthcare, engaging in daily monitoring and self-management of their condition. For people with chronic kidney disease (CKD), this means monitoring signs and symptoms and making modifications to diet, physical activity, alcohol consumption, and smoking habits. This self-management is complex, and targeted self-management support interventions play a role in assisting people with CKD to self-manage effectively. Effective self-management from early in the disease process (in stages 1-4 of CKD, before it has progressed to end-stage kidney disease [stage 5, ESKD]) can improve important long-term outcomes such as time to dialysis and survival. However, very few interventions targeting those with earlier stages of CKD have been delivered, and those that have been implemented have been largely theoretical, with significant methodological and reporting limitations.

Study Aims

To develop, implement, and evaluate a person-centred intervention based on social cognitive theory for people with earlier stages (1-4) of CKD.

Methods

This research was conducted in three phases: (1) investigation of CKD patient desires for SMS (literature review and cross-sectional study); (2) development, implementation and quantitative evaluation of the intervention – the Chronic Kidney Disease Self-Management Support program (CKD-SMS; pre-post intervention study); and (3) qualitative investigation of participant experiences of and feedback regarding the CKD-SMS (semi-structured interviews).

Conclusions

People with CKD recognise the complexity of self-management of their condition, and models in which healthcare providers simply deliver instructions to their patients to promote effective self-management are likely to be ineffective. In a relatively short time period, people who participated in the CKD-SMS displayed improved patient-reported outcomes and blood pressure. Findings from this study have important clinical implications, demonstrating that an individualised, theory-based approach is crucial when supporting self-management of CKD.